Healthcare Provider Details

I. General information

NPI: 1780901389
Provider Name (Legal Business Name): CENTRO GAMMA KNIFE DE PR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO MONACILLOS 22 RIO PIEDRAS
SAN JUAN PR
00922-2129
US

IV. Provider business mailing address

PO BOX 2129
SAN JUAN PR
00922-2129
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3535
  • Fax: 787-777-3481
Mailing address:
  • Phone: 787-777-3535
  • Fax: 787-777-3481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: MR. JOSE RIVERA
Title or Position: ADMINISTRATIVE ASSISTAN
Credential: ADM
Phone: 787-777-3535